This document discusses transitional care from pediatric to adult care for patients with chronic kidney disease. It notes the increasing numbers of young patients graduating from pediatric to adult care due to improved treatment. The challenges of transition include relative immaturity, stressful life events, risk-taking behavior and learning self-management. Poor outcomes are seen if transition is not well-managed, with some studies showing high rates of transplant loss and mortality. An ideal transition involves individual planning and preparation starting in early adolescence along with involvement of pediatric and adult care teams, family and patients. Transition plans aim to improve competencies in disease management and healthcare navigation. Barriers to transition are noted to be greater in Egypt due to extended family support pressures, lack of multi-

1. An introduction to transitional
care
Ihab Shaheen
Consultant Paediatric nephrologist
Royal Hospital for Children
Glasgow-UK

2. Objectives
• What is an adolescence?
• Facts
• Challenges
• Bad figures that need attention...
• Solutions.......

3. Adolescent is a time of increasing independence,
experimentation, rebellious behaviour and peer pressure
What this will lead to????

4. Depression, lack of secure feeling, unknown
future
&
Anger, indestructible

5. Facts...number
The number of young patients graduating from paediatric to
adult renal care has progressively increased due to improved
management ( antenatal diagnosis, dialysis in young
children, general awareness,....)resulting in patient survival
rates of 85–90%

6. Fact..... Growth and development
A comprehensive, multi professional team of clinicians,
nurses, dietitians, social workers, play therapists,
psychologists and educators is the most effective way to
minimise disabilities and maximise the potential of each child

7. Fact....support
Support for children and families from a more diverse
multi professional team is one of the major differences
between paediatric and adult care

8. Facts....different CKD aetiology
Adult nephrologists may be less familiar with the
commonest cause of CKD in young children
( Genetic diseases)

9. Fact........it is a process
Transfer is an event that takes place at the end of a transition
process designed to prepare the young person with a chronic
condition to accept responsibility for his/her disease
management

10. What are the challenges?

11. Increasing
numbers
Special
needs
Relative
immaturity
Stressful
life events
Risk taking
behaviour
Learn self
management
Transfer to
new team
Reduced
compliance
Poor
outcomes

12. UK RR. NDT 2018. 33(2):356-364
Almost 1 in 10 young adults died by 5 years from start of RRT

13. A Paediatric UK study has shown that 35% of young renal
renal recipients had lost their transplants by 36 months
after transfer to adult real care.....
Watson et al, ped neph 2000

14. Ideal transition.....
Transition from paediatric to adult renal services: a consensus
statement by the International Society of Nephrology (ISN)
and the International Paediatric Nephrology Association (IPNA)

15. Be individualised for each patient after he/she has completed a
transition plan; this will depend upon completion of physical
growth and, where possible, educational, social and
psychological attainment

16. Be agreed upon jointly by the patient and his/her family/ in
conjunction with the paediatric and adult renal care teams

17. • Take place during a period without crises, especially if there is
unstable social support
• Take place after completing school education

18. • Introduced to the concept of transition in early adolescence
(12–14 years)
• Given information about transition in a gradual manner
appropriate to his/her developmental stage and intellectual
ability

19. • Include parents, other family members and even
boyfriends/girlfriends (if the young person agrees), as more
information lessens anxiety
• Be offered the opportunity of an informal visit to the
nominated adult service before transfer occurs

20. • Be given the opportunity to participate in group sessions with
other young people who are about to transition for peer-
support experience, peer support can be complemented by
establishing a local e-mail and social networking group

21. • Be able to receive tools to aid in the acquisition of disease
self-management skills, such as the transition medical
passport

22. • Provided with a generic transition plan that then can be
individualised for each patient, most transition plans have
certain competencies to be achieved at a certain age.
Examples....

23. • I understand my condition and can describe it to others
• I know my medications and what they are for
• I can make decisions for myself about my treatment
• I know what the adult clinic arrangements are and who will be
reviewing me in clinic
• I know how to make my appointments

24. • I can make my own transport arrangements to get to the
hospital for appointments
• I know who to call in a medical emergency
• I am able to talk about my worries concerning blood tests and
other treatments

25. • I know the dietary advice that I have to follow and the
importance of activity
• I have appropriate knowledge about sexual health matters
• I have discussed smoking and drug issues..

26. We are different....Egypt
• Extended care and support provided by parents....self
management/immaturity ....more family burden
More challenging here
• Lack/no specialised nurses,dietatians....Dr’s job to arrange all
aspects..
• Psychosocial issues versus financial load..
• Private sector.....even worse